Figure 1.

Hyperechogenic ependyma as indirect sign of IVH. Ultrasound and MRI scan in a preterm infant (GA 24 weeks 3 days). (A) Coronal scan at the level of the frontal horns of the lateral ventricles shows no evidence of GMH, IVH, or ventricular enlargement. (B) Coronal scan at the level of the trigone of the lateral ventricles shows a small volume of echogenic clot within the posterior body of both ventricles (arrows); this finding was not recognized at time of original reporting. (C) Parasagittal scan through the left lateral ventricle also shows the small volume IVH (arrowhead). (D) Follow up coronal scan 14 days after birth at the level of the frontal horns still does not show clear evidence of germinal matrix clot. (E) Coronal scan at the level of the trigone of the lateral ventricles shows new hyperechogenic ependyma involving both lateral ventricles (arrowheads), with more extensive IVH within the bodies of the lateral ventricles. No hydrocephalus has developed. The presence of this hyperechoic ependyma on the follow-up scan facilitated a retrospective diagnosis of grade II GMH-IVH in this infant. (F) Axial T2^* gradient-echo MR image 3 months after birth shows increased susceptibility effect (hypointense signal) that outlines the occipital horns of both lateral ventricles (arrows) from hemosiderin/ferritin and confirms presence of earlier IVH. Several microhemorrhages were also identified in the bilateral germinal matrix regions on this blood sensitive MR sequence (not shown).